| Wonderland Pediatric Dentistry, Pc | |
|
1570 Old Alabama Rd Ste 104 Roswell GA 30076-2108 | |
| (678) 878-3711 | |
| (678) 878-3714 |
| Full Name | Wonderland Pediatric Dentistry, Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1570 Old Alabama Rd Ste 104, Roswell, Georgia |
| Authorized Official Name and Position | Karina Bogdasarova (OWNER) |
| Authorized Official Contact | 7204048805 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wonderland Pediatric Dentistry, Pc 1570 Old Alabama Rd Ste 104 Roswell GA 30076-2108 Ph: (678) 878-3711 | Wonderland Pediatric Dentistry, Pc 1570 Old Alabama Rd Ste 104 Roswell GA 30076-2108 Ph: (678) 878-3711 |
| NPI Number | 1134521990 |
|---|---|
| Provider Enumeration Date | 09/23/2014 |
| Last Update Date | 09/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134521990 | NPI | - | NPPES |
| 003146415 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DN 014759 (Georgia) | Primary |
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